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FOR OFFICE USE: -------------------- ------------------------------------ ,APPLICATION FOR SANITATION PERMIT Permit No. ..�fp --------------------------------------------------------- (Complete in Duplicate) 1I� ZI Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Lacal Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS A DLO TION.. .. -�".- ..-_.; r t`'- - !/,, Owner's Name__ �_ t-C � ---- •--/ a._ .----- 17 .A� Phone7ZI__s Address-........................ -----------------...........................1.�.1.�----?L�r� .��-------- ------ se./ ,.�./_ / Contractor's Name._ -. � � --.- j G ----4r__1------------------- Phone---- ... _ _ / o r Installation well serve; Residence Apartment House ❑ Commercial ❑ Trailer C u t ❑ Motel ❑ Other ❑ Number of living units: __/_-_ Number of bedrooms __7�Number of baths -------- Lot size --15-45,--- f_ '__-_________________ Water Supply: Public system 2--c'ommunity system ❑ Private ❑ Depth to Water Table4�?ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam�W- E]Cl y [:] Adobe Hardpan El Previous Application Made: {if yes,date----------_,______) No E] New Construction: Yes FHA/VA-. Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta Distance from nearest welL-N-�'� Distance from f�dation-____ _ _____.Material__ ffr No. of compartments________1�--------Size. ---___----•___Liquid depth_____ !_______________Capacity____ _ ' Disposal Field: Distance from nearest welll4c)Al._Distance from foundati n___________ �� Q ______.Distance to nearest lot line________. Number of lines_._.'_'�� ______ ______ _ _Length of each line___f _ ,Distance of trench..-.-��'-C------- ..__- Type of filter material_--_.Depth of filter material_____ _ '// __Total length______________________F___�__�____` i } Seepage Pi Distance to neare t well--.-7r-X1___--Distance fffjjom foundation----,-69-------Distance to nearest lot line____.__ �_ Number of pits--7----------------- material-__-1�_ac�- ____.Size: Diameter_---G3j-"'1---Depth____/______-_-___ NI Cesspool: Distance from nearest well_________________Distance from foundation---------------..--.Lining material_______-____--.------------.------__- � ❑ Size: Diameter--------------------------- ----------Depth---------------------------------------------------Liquid Capacity----------------------------gals. + Privy: Distance from nearest well-------_________---------------------------------Distance from nearest building_____________________________.._..______- Distance to nearest lot line------------ -- �1 >• A 4 �, Remodeling and/or repai mg kde cri ie�------- - --tl� ------- ----- 5.- ----- -�----�Y---- •--- ---------- --------------- ----------- ----•------ i Q+ --- - - ----------- V----------------------- .-- --- ... ---------------------------------------c'-------------------------------- -�-�, 4 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, nd rules an , regulations of the San Joan ocal Health District. (Signed) -- ---`---'----- - G -------------------- �' r Contractor) 8y%- ------------------------------------------------------------------ �(/ (Title)-- --------------- ------ - ------ ---- -- - - -------------- (Plot plan, showing size of lot, location of system in rete} n-to wells, bGildings, etc., can 6e placed on reverse side]. FOR DEPARTMENT USE ONLY``/ 9 APPLICATIONACCEPTED BY----- --------------------------------- ----------------------------------------- -`- 11--._ DATE------- ------------------- REVIEWED BY--------------------------------------------- •------------------------------------------------------•----------------------- DATE------- ----- ------ BUILDINGPERMIT ISSUED------------------------------------------------------------- --- /� r --------•-------------------------- -------------------- Alterations and/or recommendations' 1 ----- !"�--•7---------------------------------'"------------------------------------------- / -- - - -----------------------•----•------------------- ----------------------------------------------------------------- •---------------------------•------••-- ------------------------------------------------------ ------------------ ------------------------------------------------------------------------------------------ ------------------------------------ ------ ------------------------------ ---------------------------•-----------•--- -----•-----------------.-.---------------•------------------------ ------•------------------- FINAL INSPECTION BY-------------------- ------ Date--- ------- ---------------:-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California C5 9 REVISED 8-59 3M 3-'S3 F.P.CD.